Introduction to Counseling Interventions

Reflections from an assigned reading

2008-12-16T16:22:00.002-05:00

I read Larry Welkowitz's post on Errorless Modeling. I find this concept interesting and vital to teaching children with Autism. As mentioned in one of my previous posts, I shared the Audacity software with the speech/language pathologist at my school. We downloaded the program and have been talking with our technology person to get us a microphone and headphones to use with it. We've created some lesson plans around the four steps mentioned in the Errorless Modeling post.

I find the opportunity to use the child performing "perfectly" as a great way to educate them. We use a lot of visual and verbal prompts throughout the day with the children on the autism spectrum. Having this software could eliminate some of those steps by the child imitating themselves instead of the adults around them. Most children I work with are on the lower functioning end of the autism spectrum; however, I believe that this software will be valuable for them as well.

I have begun taking these skills into account when grouping my children. Instead of relying on adult cues, they can hear same-aged peers using the skills we are working on. I am excited about the possibilities that Audacity could provide for us and these children.

Reflections on class materials from 12/07/08

2008-12-15T21:04:00.002-05:00

In class we talked about friendships. This is something we place a lot of focus on at the school I work in. Many of our children have difficulty with this. Jeff defines a friend as "someone in my class." They don't spend time out of school, don't interact much throughout the day, or play together at recess. Despite all this, Jeff believes that this classmate is a friend.

In our school (and many others), the teachers refer to the children as "friends" instead of classmates, etc. I've heard (and have said) "let's go back to the classroom and see your friends." For the children with autism, I think they hear this concretely and define those children as true friends. Knowing what goes into a relationship, or even a conversation, is not a skill many of them understand. Therefore, knowing what a friend is, is a difficult concept.

The difference between absolute thinking and relative thinking is important to consider. Am I talking too loud? Is the person I'm talking to interested in what I'm saying? These are thoughts that many of my students don't appear to have. Many of my students on the autism spectrum talk very loudly or very quietly. When I ask them to speak softly/louder, they don't initially realize why I'm asking them this; it's just not something that occurs to them. Deciding if someone is interested is a constant problem. We provide them with reminders (visual and verbal) to limit their time and let others talk as well.

Not using relative thinking can make forming and maintaining relationships challenging. These are skills that are important to teach; they will have lifelong effects on these children.

Reflections from an assigned reading

2008-11-29T20:56:00.007-05:00

Attwood, Tony. (2005). Theory of mind and Asperger's syndrome. In Baker, L. J., & Welkowitz, L. A., Asperger's syndrome: Intervening in schools, clinics, and communities (pp. 11-41). Mahwah, N.J.: Lawrence Erlbaum Associates.

With an impaired TOM, there are difficulties with the conceptualization
of feelings and desires of others and oneself. (p. 21)

In reading Atwood's chapter on Theory of Mind, several things stood out to me. The stress that the families of people on the Autism Spectrum is great. The parents are not only parents, but advocates and therapists among other things. All the effort and love they put into these roles may not be rewarded with “love.” Children and adults on the Autism Spectrum typically do not express or understand emotions in the same way that “typical” people do. Since their Theory of Mind is impaired, they do not fully understand, if at all, the emotions from the other person's point of view. They do not understand what goes into a relationship and their emphasis is not on how the other person feels; reciprocal relationships depend on this.

Working with these children in the school system, I see the effect this has on parents. Sometimes they express that they don't feel that their children love them. I've seen these children show the same attachment to their parents as to me. Their parents are confused to watch this occur. Many parents have also expressed feeling guilty or inadequate. Realizing that impaired Theory of Mind impacts their child's ability to “love” in the traditional sense may help them to understand how their child is expressing love.

People with Asperger's Syndrome might express their love in
more practical terms...it is love, but not as we know it. (p. 22)

People on the Autism Spectrum tend to focus their feelings differently than others do. In Atwood's article, he includes quotes from people with Asperger's Syndrome. The definitions of love include doing things with the other person, companionship, and the “attempt to connect to the other persons feelings and emotions.”

During Thanksgiving, I did an “I'm thankful for...” activity. Discussing what this means with one of my students, Noah*, we came up with the definition of thankful as something that makes us happy or we are happy to have. He named many objects, such as birds, chicken nuggets, and waffles. When I asked him if any people make him happy, he thought for a moment and said no. I've seen this child interact with his mother, grandmother, and sister and he does appear to enjoy their company. The basis of their relationship, however, is difficult for this boy to express or understand.

The children I have worked with focus on what their parents do for them, rather than how they feel about them. I asked Jacob*, an eight-year-old boy with Asperger's Syndrome, why he loved his grandmother. He stated, “well, we go bird-watching together.” When prompted further, he mentioned her cooking dinner and helping him with homework. While these are greats things in their relationship, Jacob was not able to attach any emotion to his grandmother.

Understanding how an impaired Theory of Mind can affect so many aspects of a child/adult's day, will help me to be a more effective therapist. Explaining this to teachers and parents may alleviate some of the daily stressors, such as behavior (“He did that on purpose!”), inappropriate comments (“I can't believe she said that to him.”) and difficulty expressing emotions (“Why doesn't my child love me.”).

A social story provides information on the where, when, who, what, and
why of social situations. [Social stories have been] found to be remarkably
effective in improving both understanding and social and emotional behavior in people with autism and Asperger's Syndrome (p. 31).

I have found using social stories to be an invaluable tool in teaching children with autism and Asperger's syndrome. By presenting a potentially uncomfortable situation in a safe environment and with needed supports and tools, proves to be an effective method of teaching vital information.

I have written and provided numerous social stories to my students. One in particular, Joey*, frequently reads through his social story library throughout the day. One of the stories is regarding behavior in the classroom. A page in the story states that using a loud voice can hurt his classmates ears. There is a picture of a person covering their ears with a sad face. When Joey first received this book, he read each page without a visible reaction. After a week or so, Joey would read the book out loud to his paraprofessional, and began getting upset at that picture. He eventually started to cry when reading that specific page. As Joey processed the information, it seems that he began understand how his actions affected his peers. His raised voice has begun to decrease.

Although this section states that no published studies exist regarding the efficacy of social stories on Theory of Mind tests, many of my students find them to be useful. This chapter made me think about the way in which to write these stories, including the four sentences: descriptive, perspective, directive, and control. Using these guidelines, I may be able to create more effective stories.

*All names have been changed to maintain confidentiality

Reflections on class materials from 11/16/08.

2008-11-29T18:36:00.002-05:00

A lot of useful tools were introduced in class. One I found particularly interesting was the Audacity software. A download that provides an opportunity for voice matching is a wonderful tool. Speaking in halted sentences and typically a monotone voice can have social repercussions. Information I learned from class was that people tend to be drawn to others that match their flow of speech. Children and adults on the Autism Spectrum have trouble with this, making it difficult for them to form relationships with others. I know that having a conversation with someone who is monotone results in my attention wandering. I'll listen in the beginning, but that person has lost my attention very quickly. Since children and adults on the autism spectrum have difficulty interpreting facial expressions, my speaking partner probably doesn't realize that I've lost interest and they need to bring me back in.

I believe that the most useful part of the Audacity software is the opportunity for errorless modeling. Giving a person the chance to hear themselves performing perfectly is invaluable. Many of the children I work with are echolalic, so listening to themselves will prove to be a great tool. I find that these children will echo my speech perfectly, including rate, flow, and pitch. If I can provide a model with the expected qualities, have the child echo it, and record them speaking with the ideal speech, I can start a new pattern for them.

Another interesting thing introduced in class was the idea of peer mentoring. I initially thought that this idea would be geared for a much older audience. However, I thought about this on the drive home and realized that although the children I work with are younger, I don't think it would be a bad thing to introduce this on a more basic level. Encouraging “buddies” who the children are comfortable with to go for a walk or play at recess. There are many classmates who are more than willing to spend time with my students if they knew that's what they wanted. By intervening at that first step (which can be very overwhelming for these little ones!), they can work on establishing a relationship.Providing a social situation with support is a great way to get them involved with other people. A group of supportive friends are introduced without the difficulty of gaining those friends. While effort is needed on the side of the child/adult, some of the pressure is alleviated through this mentor relationship.

2008-11-29T17:00:00.003-05:00

My name is Casey and I am an occupational therapist working in an elementary school in southeastern New Hampshire. I work with children from three years to nine years old. 30% of my caseload consists of children on the Autism Spectrum, of which four are considered non-verbal. I am currently attending an Autism Spectrum Disorders certificate program at Antioch University New England in Keene, NH. This blog serves as a medium for reflecting on the assigned readings and information presented during my Introduction to Counseling classes.

I am hoping to gain some insight on how best to work with my students and their families. One of my goals is to learn more about interventions to highlight the strengths and address the weaknesses of these children. By the end of this class, I am looking forward to learning how to integrate technology into my therapy sessions, both low- and high-tech.